PROVIDERS

We are dedicated supporting our providers.

Provider Information

Provider information is maintained on a daily basis by the PsycHealth Provider Relations Department.

If you have any questions about the provider information displayed by QC Portal, please contact the Provider Relations Department at providerservices@psychealthltd.com.

Member Eligibility

Please note that Member eligibility information is received on a monthly basis from the medical groups.  As such, there may be a lag of up to 30 days between the time the medical group makes a change to the member’s policy and when that change is reflected by QC Portal.

If you have any questions about the eligibility information displayed by QC Portal, please contact the Clinical Care Department at memberservices@psychealthltd.com.

Provider Notice

Effective 6/1/2016 all in-network contracted Providers with PsycHealth Ltd. will be able to view and print their Explanation of Benefit reports directly from the secure PsycHealth QC Portal website. PsycHealth will no longer be mailing these EOBs along with the checks.

Once logged into the portal with your ID and Password, select from the Menu – EOB/Payment History.  You will be able to select the EOB by Payment Date.  Most recent payments are listed first.

If you are an Out of Network Provider, PsycHealth will continue to mail you your EOBs.

If you have a problem with your ID/Password or any questions regarding this process please fill out our contact form.

Providers will no longer need to wait for mailing of payment to begin posting accounts because EOB will be available immediately after printing checks.  As a reminder printing checks is on 15th and 30th (31st).

Medical Necessity

PsycHealth, Ltd. utilizes and maintains explicit medical necessity/clinical review criteria that are:

  • based on current clinical principles and practices;
  •  and developed with involvement form appropriate providers with current knowledge relevant to the criteria under review.

The 2016 screening criteria to be used for all prospective, concurrent, and retrospective review and case management activities are:

  • Apollo Managing Behavioral Health 20116 for medical necessity determinations;
  • and ASAM Criteria for Substance Use Disorder Determinations third edition, 2013.

Upon request to the Quality Improvement or Clinical Department providers may obtain a copy of any criteria utilized in making a medical necessity determination.

Practice Guidelines

PsycHealth Peer Review committee adopted in the last quarter of 2015 the American Psychiatric Association Practice Guidelines latest edition for use in 2016.

Three practice standards for assessment of performance measurement for 2016 are: ADHD, Schizophrenia and depression.

For more information please see APA’s practice guidelines.

Case Management

Providers have the ability to request case management and complex case management services for their members through the Provider Portal or over the phone.

Referrals and Authorizations

Referral and Authorization requests are reviewed on a daily basis by the PsycHealth Clinical Care Department.  The current status of any request can be viewed via QC Portal.  All referral and authorization requests will be processed in accordance with terms set forth in the PsycHealth Provider Contract.

If you have any questions about the status displayed by QC Portal, please contact the Clinical Care Department at memberservices@psychealthltd.com.

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Claims

Claims submissions are reviewed on a bi-weekly basis by the PsycHealth Claims Department.  The current status of any claim processed by PsycHealth can be viewed via QC Portal.  All claims submissions will be processed in accordance with Illinois law and PsycHealth claim polices and procedures.

If you have any questions about the status displayed by QC Portal, please contact the Claims Department at claimsinfo@psychealthltd.com.

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Quality Programs

PsycHealth, Ltd. has ongoing quality programs and initiatives.  These are reviewed each year.  The reviews let us see what we are doing right or what we can do better.  We also look at complaints and satisfaction of our providers and members.   For more information, contact our Quality Department.

Alternate Modes of Operation

From time to time, PsycHealth will use the System Messages to convey important information to providers.  Please review the messages on this screen as they may indicate when QC Portal may be unavailable for use due to system maintenance and/or upgrades.

QC Portal is an internet based application and is subject to occasional outages.  If the QC Portal website cannot be reached for any reason please contact us so we may resolve the issue. Please note that most outages are resolved within 24-hours.

Provider Portal

The Provider Portal, also known as QC Portal, is a comprehensive managed care software that is highly flexible, easy to use and powerful. The software allows PsycHealth providers to verify eligibility, enter referral and authorization requests, submit claims and view the status of all data in real-time from any internet web browser.

Member Eligibility

QC Portal uses real-time data to search and preview member eligibility.

Referral History

QC Portal allows for searching for outpatient mental health service records.

Authorization History

QC Portal also can display authorization history, including inpatient, partial, and intensive outpatient mental health service records.

Claim History and Submission

QC Portal additionally allows for viewing claim history and submission of manually entered claims and 837 EDI files.

Call Logs

QC Portal can show the user up-to-date electronic medical records through the call log system.
Self-Determination in Mental Health

Self-Determination in Mental Health: The Benefits of a Psychiatric Advance Directive

Advance directives play a significant part to ensure that needed and acceptable treatment and care are provided in a timely manner.  The Declaration for Mental Health Treatment (Declaration) is an Advance Directive. The Declaration is often overlooked and rarely discussed unless the patient is in a state of repeat or continual crisis.  This is a mistake. Depriving a person of the opportunity to have the knowledge about and choice of such a tool interferes with the ability to exert control over their life and illness.  It is time to shake off the stigma concerning a mental health advance directive.

The benefits of a Mental Health Declaration or Advance Directive provide patients with an opportunity to state the type of treatment they prefer. Whether the treatment is psychotropic medications; ECT, hospitalization or any combination of treatments, a clear written statement of the patient’s preferences is made through the Declaration.  Once signed, dated and properly witnessed by two witnesses, the Declaration is enforceable in Illinois for three years and will continue in effect until the patient is no longer incapable of making treatment decisions as determined by a physician. The benefits of the Declaration are;

  • Ability to make needs/illness known to healthcare providers
  • Ability to appoint an attorney-in-fact to act as directed by the Declaration
  • Treatment is rendered without multiple provider assessments
  • Care is implemented in a timely manner
  • Less time spent in the Emergency Room
  • Less anxiety for patient and family members
  • Increase ability to keep illness under control
  • Decrease in critical events that may prolong recovery/stabilization
  • Ability to select the agent

Take time to become familiar with the Declaration for Mental Health.  There are many patients who will benefit from this tool. Like all Advance Directives, the Declaration is revocable in whole document or in part.  In Illinois revocation is effective when it is communicated to the attending physician in writing and signed by the patient.

Self-Determination in Mental Health PDF
Provider Manual
Contact Us
Office Telephone: 847-864-4961
24 Hour Telephone:1 800-753-5456
Office Hours: 8:30am – 4:30pm  Monday-Friday
E-mail: contactus@psychealthltd.com
Administration: administration@psychealthltd.com
Member Services: memberservices@psychealthltd.com
Provider Services: providerservices@psychealthltd.com
Claims Department: claimsinfo@psychealthltd.com
Utilization/Case Mngmt: um@psychealthltd.com
QC Portal: qcportal@psychealthltd.com
Help Desk

The PsycHealth Help Desk for Member Portal related issues can be contacted via the following form or at: QCPortal@psychealthltd.com.  Please be sure to include your name, telephone and email address when submitting an inquiry to the Help Desk.  All requests will be addressed within ten (10) business days.

Your Last Name (required)

Your First Name (required)

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Your Phone Number (required)

What do you need help with? (required)
 Login/Access
 Claims inquiry
 Eligibility inquiry
 Referral/Auth inquiry
 Other

Are you a member or a provider? (required)
 Member Provider Other

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